The Logic of What Might Be

We have a healthcare (insurance) reform bill passed in theory and probably soon to be passed in actuality.

The next question is: what does this mean? What does it mean, politically, functionally, to you, to me, to many others that don't have the wherewithal, desire, or ability (as a result of no connectivity or not having connectivity, if you know what I mean).

Well, if I summed it up quickly, it would go like this:

What does it mean politically?
It means that we have a president and a congress that has been in the position and created the positioning to push something through in about a year that has only been done a handful of times in the short history of the U.S. democracy.

It means that there will be attacks that happen any time any individual or group overcomes aggressive political opposition to accomplish something that the opposition vowed publicly and privately to completely derail.

It means that implicitly, something that has never been done is being done by a figure that has done something that has never been done.

It means that explicitly what we will hear is that when a figure that has done something that has never been done twice, the ultimate outcome is that there will be grave consequences because what has been done can't be that good. "There is no proof."

What does it mean functionally?
Functionally, it means that things are going to shift, some slowly, some within the next year. It means that some of us will pay a little more, some of us will pay a little less. It means that some of those folks with no connectivity or less than functional connectivity will have more opportunity to connect with things they need to feel and be connected.

It also functionally means that until we get accustomed to the shifts, that we may feel a little uncomfortable. It means that not everything that certain people wanted will be on the table immediately and in some cases not at all. There is no way this could have been all things to all people.

The inevitable consequence is that some companies and individuals that are already making a large sums of money from healthcare, will more than likely continue making large sums despite the varying stances on this dynamic. In fact, I am not sure if that would have changed more than a couple percentages in any direction because in reality, functionally, those making large sums anticipate how they can make money despite political outcomes. If we look at it logically, it is smart business. If a company does not anticipate what could be, they are subject to whatever is when it surfaces without any ability to turn the rudder when the ship requires a change of course.

So, that brings me to the title of this post. . ."The Logic of Might Be". This statement comes from Roger Martin talking about "abductive logic" in his book The Design of Business. Thinking abductively or proving what might be, asserts that past-based logic is not the only logic that drives our predictions of success. This way of looking at problems doesn't guarantee success. Nothing guarantees "success" where outcomes are concerned.

However, what it does is creates a space that allows for exploring possibility. In fact, to me it allows us to validate not just a single possibility but multiple dynamics simultaneously.

I can honestly say that I am quite disturbed that in this country that we have become so polarized that there is absolutely nothing that we can rally around as a idea that is good for us all. In fact, it seems that whenever such an idea comes about, we, the media, political parties, whomever, seeks a contrary position and drives that resistance so quickly and aggressively, that most people take a side. They seemingly do so because dichotomous options occur to them as the only options possible. This is the Logic of What Was or What Has Been.

In this healthcare insurance reform question or any other critical issue facing us in this current reality: Can we explore "The Logic of What Might Be"? or Will we stay limited by inevitability trapped within the cycle of what has been?

Make it a great day!

Predictive Modeling of the Masses

My observation of the healthcare insurance reform debate and the war debate and the Tiger Woods debate and the economy debate and the obesity debate and the. . .is that there a lot of debates. There is little action towards an idea, centrally agreed upon that will move the U.S. and perhaps the world forward.

So, I came to the conclusion that all of us have become coffee table, computer desk, bar, stationary bike, recliner, barber shop statisticians as we are all engaged in Predictive Modeling. Let me briefly explain.

Predictive modeling is the process by which a model is created or chosen to try to best predict the probability of an outcome. (Geisser, Seymour (1993). Predictive Inference: An Introduction) In many cases the model is chosen on the basis of detection theory to try to guess the probability of a signal given a set amount of input data (Wikipedia).

The difference with us armchair statisticians in regard to predictive models for healthcare reform is that our models (for the most part) are not based on "detection theory" as described above. If so, that would mean that there was some level of understanding about how we discern potential outcomes. In most of the situations that we currently face including health insurance reform, the dynamics are completely without discernment.

In fact, most predictive modeling going on currently is based on one or a combination of: Self Interest, Fear, Preferred Media Outlet, and in the case of healthcare reform one's general depth (or lack thereof) of knowledge about healthcare.

Now, my biggest concern about the entire dynamic that we are facing is that given the circumstances (maybe given any circumstance at any time), speculation about what will happen in the future that is so highly unpredictable is a formula for failure and perhaps a formula for mass paranoia. It is not worth it.

What is the alternative? Well, I will stick to what I am most familiar with and what is the subject matter of this blog. . .Moving healthcare forward, in my opinion, will be much less dependent on reform of the system than it is on a paradigm shift in our organizations and individual consumers. The fundamental premise of healthcare is not cost, it's people, quality, and care in that order. I recognize that we have to make money to stay in business, those that know me will tell you I am far from naive in that regard.

However, the "money first" strategy has gotten us where we are in healthcare. The heuristic that emphasizes care is grossly compromised by financial considerations. In a model where people come first, efficiency is created through effective communication. Doing things well early in the process and setting the stage for effective self-care will inevitably save money.

Let's try this as a premise--1) focus on people/patients; 2) with this focus learn what effective communication is for each patient--make developing cultural competence central to effective communication; 3) resolve that effective communication for a year and the investment into it (not a highly expensive one) will impact quality/core measures more than anything else a healthcare organization can do.

Now, this premise is not going to quell the voracious appetites for the predictive tweeters and bloggers, ranting on about how the world is coming to a halt due to the actions of a single leader in one year. Nor will it make those demanding a public option without knowing enough about the pros and cons to do anything more than make an emotional plea.

What the premise above or any other premise you suggest can do is move us towards something we commonly agree on with the intent to use this heuristic to prove something or disprove something rather than speculate ourselves stagnant.


Make it a great day!

Cynics and Possibility

I often envy cynics. In the midst of change they can so easily begin their critique of the current realities. Or they can take a premise (the central idea of any breakthrough innovation) and dismantle it purely based on their past-based data and understanding alone.

In the past my orientation to the cynic went somewhat like this: In scathing displacement they deftly spin their cocoon, a blanket of protection which ironically seems to be woven in resistance to the transformation that deep down, they desperately desire.

I am not so sure that this is the case anymore. In fact, it may be that cynics are intentionally playing a role. So, the idea of the devil’s advocate may come to mind, but I think it is more profound than this. For the self-professed and consciously (perhaps conscientiously, too) engaged cynic, their role seems to be one more so that of a constant reminder to look at problems from as many angles as possible. In addition or alternatively their role is also to serve as adviser to the power of intuition.

If you feel it strongly in your gut and it is not challenged, the integrity of the idea never stands up to anything strong enough to be for certain that it is anything more than a fleeting good feeling.

Let me give an example of why I am learning to appreciate cynics more today than ever and why I think they are the some of the best generators of possibility.

Over the past several years my work has led me to generate many premises about human capital dynamics. Most recently, the premise that a focus cultural competence and quality and the components that create and drive the above, are the core of success in any healthcare organization and perhaps in any organization period where quality is valued. The components, especially inclusive leadership and employee engagement have come to be core to the premise in that they are critical in producing sustainable results.

So, I have this premise and some of the people in organizations that have agreed that this premise is worth pursing are going about testing hypotheses and questions that relate to the ideas of our model. They are of course leaning heavily on those components that serve their specific needs right now.

What the so-called cynics have done for me is inspire me to not be stuck on a single point of possibility. Where before I recognized that the various parts of our model can give organizations a way to connect the often separated components of organizational development.

Lately as a result of some of my ideas being challenged and sometimes told to not be practical or feasible, have given me insights towards possibilities that simply were not considered before. I see the value in going deeper into any one component of the model and connecting to the others naturally without having to do 8 other things to legitimize the premise. I questioned a central premise based on a cynical response and in my questioning I discovered a new space to explore and share with you.

Now, my envy for the cynic is not envy for their being cynical but appreciation of what they inspire and hopes that I can take on a little more of their characteristic skepticism in order to create and recognize possibilities as they arise.

Make it a great day!

Everyone's at Fault-Everybody's at Risk

In the healthcare insurance and healthcare reform debate (I consider the financial side a part of overall reform, but it is not the complete picture of reform) there are obviously sides that have been taken.

On one side is the "'we need universal healthcare', 'we need a so-called 'public option'; 'healthcare is a right not a privilege', 'those bad health insurance companies are bringing us all down,'" contingency. You are familiar with this side or you subscribe (at least in part) to it so you understand it experientially. On the other side is the "'this costs too much,' 'I like my healthcare just the way it is,' 'we are turning to socialism,' 'I really don't know what is going on with health insurance reform, but if it is anti-Obama I support it'" crew.

The fact is, both of them are creating something that we have seen often in the political process, They are creating an ever-narrowing bottleneck to progress.

In 2006, Harvard Professor Robert Putnam, author of the best seller Bowling Alone and an expert on human/social capital wrote a widely debated paper on social captial, increasing global diversity, its challenges and opportunities. His statements, when taken out of context indicated that he was anti-diversity, when in fact his intention was just the opposite. Writer William Goldsmith of the Harvard Crimson shares an interview with Putnam:

In more ethnically diverse communities, respondents were more likely to “hunker down.” Those results held true even when Putnam controlled his study for a host of other factors that might affect trust levels—including gender, education, and income.

“We act like turtles,” Putnam said. In diverse communities, people are not only less trusting of neighbors from different backgrounds, but also of those from their own ethnic and racial groups.

Los Angeles, one of the most diverse cities in the world, has the lowest level of trust in the United States, Putnam said. He attributed this to a “socio-psychological system overload,” a type of shock resulting from an influx of heterogeneous newcomers into a generally homogeneous society.

But Putnam said people’s turtle-like behavior when first confronted with diversity fades over time.

What is my point? Like this article by Putnam, interpretation is creating the outcomes vs. facts driving the dialog doing so. People saw all of this change in their surroundings and they began to trust no one, then they began to look to those who were as scared or as vocal as they were or desired to be to connect with.

By nature of the topic and historical political factions, the dynamic is inherently emotional. Of course, the emphasis on philosophical differences that has been primarily perpetuated by extreme so-called conservative groups is a much more viable tool in emotional manipulation.

However, in the situation the U.S. is in where healthcare (and our overall economy and society) is concerned, the result of creating emotionally-based bottlenecks is that everyone loses.

Indeed, there are many things to consider including the idea of increased taxes, how to pay for this whole thing, the dynamics of reform beyond cost: namely cultural competence and quality and all that they entail including health disparities, patient-centeredness, and other essentials to real reform. There is also the cost of perpetuating a self-destructive paradigm for our society that is based in too large a part on financial gain.

So, short-term thinking and political jockeying is creating the appearance of something that is dichotomous because the paths to getting where we know we need to be have slight philosophical differences. And of course who will take the credit (negatively or positively, visibly or invisibly) plays a major role, too.

The fact is, we are all at-risk of severe consequences as a result of this political cacophony (sounds redundant, huh). Health (insurance reform) is not just about health insurance reform (see Parrots and Protectionism). Our response as members of a society that desire to see our country evolve is very much a determinant of eventual outcomes. In fact, while we don't have 100% of the say in how this whole thing goes, our attitudes are being probed for and our ignorance is being preyed upon (and it is not party-centric)

I am not talking about whether or not there is a public option. I am not talking about who pays (the bottom line is that regardless of the outcome, we all pay and the cost is not going to be considerably lower. I hope that at the least we can keep it from increasing beyond the cost of inflation) or how much. My concern is that we keep this mindset that someone is taking something away from "me".

NEWS FLASH: It has ALREADY been taken away! If we understand this, mentally lying down along political lines will be less restful. If you "sleep" on either line you will be at fault.

Make it a great day!

Go Beyond the Surface

It has been a minute since I had an entry. It has not been a break from the conversation, just one from my writing about the cultural competence and quality on our blogs.

This one will be short. It often occurs to me that we often think about health disparities purely from a deficit model. We approach the prevalence of adverse health outcomes with the notion that our opportunity lies solely in fixing what's wrong.

It is natural to try to repair the wrongs, especially when they are driving our intention. The issue with this is that it is a purely past-based approach that inherently leaves us with limits. We are limited in the sense that we begin to look for the root of problem and then spend countless hours and endless conversations about changing the root.

The problem is that the root is resistant to change just like we are. In fact, if I were to stretch a little, I would say that where health disparities (aka quality disparities) are concerned, trying to get at the root causes and change them won't work. Of course, I don't think change works all that well either.

When we enter into the conversation about health disparities, it is important to do a strengths inventory as well as understand the dynamics of disparate outcomes on the negative side. In example, is the "Chicana effect" with birth outcomes. This term has been used to indicate that interesting fact that low birth weight birth outcomes are similar to that of whites and in some instances have been found to be lower regardless of social-economic status. It has led researchers to conclude that there are things socially and culturally within Latino/Chicano culture that are protective in nature.

If research and/or anecdote via our experience gives us insight into a positive health outcome in a particular community, it is vital that we look at the dynamics involved within that outcome. They may be sociocultural, they be structural, they can be a number of things. And it is possible that they can be leveraged in our cultural competence and quality efforts.

Make it a great day!

Health Care Reform: Is it all about costs?

There is one mystery - yea-ea-eah - I just can't express:
To give your more, to receive your less. Bob Marley

The conversation about health care reform has lead all of us to ask the question: how much will this cost? It is a very important question and one that has to be addressed every step of the way. What this leads one to think is that the concern that opponents have is purely financial.

On the other hand, supporters of health insurance reform, especially those who are supportive of a public option or something resembling universal coverage, speak about the cost of doing nothing or less than the creation of a public option.

So, the question is: Is Healthcare Reform all about Cost?

My answer: Yes, healthcare reform is all about cost.

Now, there is an angle that both those who are worried about cost on the anti-reform side (in the forms being presented currently) and those who are concerned on the pro-reform side have to consider. Fundamentally, in life and in business, you cannot get something for nothing. Or as my hero, Robert Nesta Marley asks: "How can you ever give your more to receive your less?"

Fact is that you cannot, not now, not ever. In fact, I could go as far as stating that the problems that we are experiencing in the current economy have been created based on a "give your less to receive your more" mind-set.

In its course, some have benefited from the exploitation of this anti-principle. However, the correction that is necessary in a universe based on the natural laws of cause and effect always runs its course. If something is out of balance, correction of the imbalance will occur. It doesn't matter how long it is delayed, it will eventually move back to the even mark.

Without a doubt we are in a mode of correction. For such a long time whether it was during the dotcom era when "money was for nothing, and. . ." (you know how the rest of that line from Dire Straits went) or the so-called real estate boom (or was it a cover for the dotcom bust) and now where are we?

Over and over, we have created situations that have the inevitable consequence of suffering. Yet, because we think that giving our less and receiving our more is possible, we continue in this cycle, and then we complain.

We blame this corporation, and this bank, and this president, and that billionaire, and that job, etc. In many cases, the blame is understandable. There have been many companies and wealthy people that have exploited systems and people to get more for less time after time. This I do believe.

What about now? What about health insurance reform? Now our focus returns to the focus on the individual without regard to other humans. Have we truly learned anything about this paradigm? Millions of people have been so very much focused on their financial well-being/abundance that they choose to disregard the well-being of others. In fact, they have created a body of rhetoric that actually classifies their self-concern as patriotic, American, capitalist. They are framing healthcare reform as a threat to their way of life, our freedoms.

So, healthcare reform is all about cost, but it is not all about MONEY!

Cost transcends dollar and sense. A lack of compassion costs society much more than a few dollars. On a fundamental level it erodes the foundation of who we are as a nation. It compromises what makes one human; and in the final analysis, especially in the times we are in now, determines who we choose to be as a United (or not so United) States of America.

We are at a crossroads in the direction we want our country to go. It has little to do with health reform, its costs, or its outcomes. However, it is absolutely reflective of the tenor of the conversation and the desire we have to uplift humanity vs. simply find ways to protect what we (in a very short-sighted understanding) think serves one's individual interests.

Healthcare reform is all about costs, yes. Yet, we must consider all dimensions of what costs translate into--all are attached to our pocketbooks--All are attached to our destiny.

Make it a great day!

Parrots and Protectionism: Healthcare Reform and American Society

"Most people would rather die than think; in fact, most do so"
Bertrand Russell

Critical is not something that my closest friends would consider me. Today I will contradict that sentiment.

The realities of healthcare reform are still not clear to most Americans. While the factions that have emerged from the each pole from Universal Coverage to Anti-Reform (aka "keep things like they are they are good/comfortable for ME right now") the clarity on either side and even for those who desire a more middle of the road approach has been murky. This morass of confusion has at times been calculated and intentional. More so, it has been the result of many people on Twitter and through various blogs and other social networks and media parroting the sentiments of a faction of people and in some cases a particular person whom they feel is a reflection of who they are.

Human nature is what human nature is. We gravitate towards that which makes us feel safe and protects the values that we have come to know as most beneficial to our survival. However, the caveat to this reality is that things inevitably change. If we are lucky and thoughtful, change can be the precursor to transformation; however, transformation is rare. The result that arises when transformation is necessary but is resisted based on an unconscious reaction to that which is beyond the scope of consciousness, is decline.

The healthcare reform conversation is reflective of the decline of the United States and it will not cease declining until this conversation and people having it transform, starting with a change (if only for a moment).

Changes will need to come in one or two forms. For those who are aware that they are in fact spouting un-truths or half-truths (same thing--see Beware of Half Truths About Healthcare Reform) based purely on self-interest will have to realize that a mind set based on selfishness and motivated primarily by material gain will not be rewarded in the long-term.

Of course, some people are aware that it is the case. They are clear that the material growth of the U.S. is in the process of decline and that while we will potentially/eventually get to a place where suffering is mitigated, riches "beyond belief" will rarely be seen and for that matter, valued like many value them currently.

The rich will stay rich and what we consider the middle class will shift significantly and the gap between all social-economic strata will broaden. Nonetheless, although they have this awareness they are not willing to do what it takes to consider a broader interest beyond themselves. Some of these voices perpetuating a divide of the people (the "socialist healthcare" "killing off seniors" "making you pay for other people who don't want to work" and "all those immigrants bringing down our country" stuff) will experience severe negative consequences to their fortunes and their lives. This mind-set is dying and if you have a dying mind-set you will eventually. . .well, you get the picture.

Now on the other hand, my opinion is that there are droves of people who simply react or parrot the sentiments of others. They liberally react with the "We Are the World" conversation that Universal Healthcare is a must and all people opposed in any fashion are racist, fascist, separatist, selfish humans who don't care about all of those people in need.

Or, conversely they parrot the Rush Limbaugh's, Glenn Beck's, Sean Hannity's, etc. of the world and simply repeat their self-interested rhetoric that is so clearly one-sided that one actually has to intentionally not think to believe that their perspective is balanced or even remotely speaking to the entirety of interests of those that they have influenced to duplicate their misdirection and misinformation.

So, we are stuck between the selfish, parroting, and extremists. Where do we go from here?

First, I think we have to recognize that healthcare reform is about more than just healthcare/health insurance reform. In fact, the topic is simply a microcosm of the dynamics of American society and an opportunity for us to enter into a new era where transformation from an "I" to "We" consciousness is created. I have said and will always say:

"The difference between Illness and Wellness is 'I' and 'We'." and I am not just talking about our physical illness and wellness.

What is at stake is a reflection of the myriad challenges that face us and that we will have to take on together, not divided to ever have a chance at improving. Whether it is education, energy, the environment, healthcare or any other vital issue, we are now at a time that leads us toward evolution or self-destruction. ALL of us are in this space. Extremes of thought, reaction, and rhetoric in either direction will perpetuate the decline.

Second, we can't make this process we are in with healthcare reform about win or loss. If there is win and loss, there is loss--all of us lose. Whether you are affected directly or indirectly, if there are sides and any side is adversely affected by the choices made to the point that their suffering creates greater suffering for others, we all are harmed--the United States is harmed--the world is harmed.

If you are considering dismissing what I am saying because it is uncomfortable, so be it. My intention is simply to state what I see and what I think is inevitable if we do nothing or do less than we are capable of as a very capable United States of greatness.

The discussion we are in now is VERY very big. Very big conversations lead to very big consequences when subsequent actions or non-actions are taken. This time WE choose. We, the People, are the government and our elected officials are extensions of us. WE choose the rise or fall this time by our words and our thoughts. This has always been the case but the quickening of information exchange and the speed of the times exacerbates it.

Third, parrots are some of the most intelligent of animals on the planet. They can be trained, not just to mimic voices and repeat words, but also to speak in context and solve puzzles. The parroting that I am talking about is devoid of real thought and is dominated by emotional reaction, not rational contemplation.

Don't be fooled by a small faction stating small-minded perspectives without thoroughly examining all sides of the situation. Otherwise, you will think others are "drinking the koolaid" while you are actually unaware of the reality that the "others" in fact, are you. Voluntarily parroting incomplete sentiments of manipulation is reflective of how deeply one is being manipulated without awareness. Teach/require yourself to think.

We are a thinking country, it is what brought forth what we have created, the good, the bad, and the ugly. We have stopped thinking deeply, we rather choose to repeat the thoughts of others. It cannot continue, it will not help you, it will not help your family, it will not help our country.

So protect the greatness that we have created in this country. If you must repeat the thoughts of others solely because you are only worried about yourself, let people know. At least we will be clear about your intention.

In the space and place we are in now, the time couldn't be more critical. We absolutely must open our minds, deepen our consideration, and learn the intentions and necessity of transformation. Healthcare reform and its dialog can be a platform for us to make this a reality. Let's create what we truly want to see in the world.

Make it a great day!

Cultural Competence is a Strategy II

I doubt that strategy and struggle have a common Latin root.

What I don't doubt is that they go hand in hand if success is desired.

With any change process, there is resistance. In many instances the resistance can even exist amongst those who want to actually see the change move forward. They may fundamentally believe in the idea of transforming the way their organization gets healthcare (or whatever their business is) done; nonetheless, something they cannot fully understand about their thinking or approach leaves them with results that are less than desired.

Why does this happen? It happens because CHANGE DOESN'T WORK.

Let me explain using a device that I found quite fascinating when I first came across the ad that read: "Drop 2-3 dress sizes in less than 10 minutes." When I first read it and then saw the pictures and read the testimonials on the postcard that was left on my car one day, I began to wonder how long this 2-3 size drop lasted. I was compelled to learn more because I have read about a lot of diets from The Zone to the Master Cleanser, and none of them promised results in such a short period of time.

As some of you who watch Oprah probably know (of course it was on Oprah!), this device is not actually a diet. It is in fact a very efficient body compression, girdle-type device that apparently allows one to wrap themselves up thus compressing 2-3 sizes worth of "love handles or other handles" that one has, leaving them visibly thinner under their clothing.

I am not discounting this device, it has its place. It creates change and from the outside, if you saw a person with one of these compression devices on, you would naturally perceive them to appear a certain way. They may appreciate your perception as their intention was to present themselves in a particular light.

Now, the person wearing this device changed, but how long did that change actually last? What will be required to sustain that change?

The answer: it cannot be sustained. It can be repeated and it can be replicated, but it cannot be sustained because CHANGE DOESN'T WORK. It doesn't fail because we are not sincere about our desire to see lasting results. It doesn't fail because the intention is not sincere or carefully considered. Change doesn't work because as long as it is viewed as change it will be resisted and it will be changed again. Change is a tactic. Some tactics have longer-term success than others but in and of themselves, they fall short of creating results that are sustainable.

So, change is like the love handle compression device shared above. It is a tactic that creates the appearance of a desired result, but it is not the desired result because its not possible for it to be sustained. 10 minutes to decrease 2-3 dress sizes is akin to doing a 2 hr, 4hr, or two-day "diversity" or "cultural competency" training and expecting that the learning will be sustained and put into practice. I am not saying that it doesn't have a positive effect and given that we deliver training as one of our services, I recommend it. However, I am very clear that it is a tactic in an overall strategy that takes more time and more struggle.

Cultural Competence is a Strategy--it is an organizational development strategy. If it is framed as such (and aligned with your overall organizational quality strategy) it can be a transformational strategy. Transformation is sustainable as it implies that the process leads to a place where what your organization is doing tactically transcends the moment of implementation and speaks to practices becoming part of what I call your "Organizational Being". This is in contrast to "Organizational Doing" which speaks to something temporary and consciously or unconsciously viewed as marginal to success.

A solid cultural competence strategy takes struggling with current mindsets, norms, and a variety of other conversations that we have become accustomed to that require a shift of perspective to create quality healthcare delivered in a patient-centered, culturally competent manner.

Next time I will speak briefly on leading your cultural competence efforts strategically.

Make it a great day!

Cultural Competence is a Strategy

Human capital strategy is often considered to be a process that consists of many parts that operate separately. While this is a practical way to get certain things accomplished or checked off of a list, it is not a strategy.

What is a strategy?
I found many definitions for the term "strategy" when doing a search. Most of them were framed around military strategies. This one from Wikipedia resonated most:

A strategy is a plan of action designed to achieve a particular goal. The word strategy has military connotations, because it derives from the Greek word for general.

Strategy is different from tactics. In military terms, tactics is concerned with the conduct of an engagement while strategy is concerned with how different engagements are linked. In other words, how a battle is fought is a matter of tactics: whether it should be fought at all is a matter of strategy.

As our Cultural Competence-Quality Framework evolves and begins to be adopted by healthcare organizations, one fundamental premise is that the CC-Q Framework is to be leveraged as an integrated human capital strategy inclusive of and dependent upon many parts working in concert, fostering sustainable quality for every individual and organization that you seek to influence through your healthcare organization.

For example, in many organizations the focus of the quality efforts are relegated to those responsible for core measures. Occasionally, there will be a report in a leadership meeting and questions will be asked about certain things. However, it is the exceptional organization that is talking to those responsible for cultural competence, diversity, and inclusion about nuances based on individual values, beliefs, and responses that may be confounding core measures, leaving valuable information as a missing variable to ensuring a consistently positive patient experience.

This is not to say that every individual is going to be 100% satisfied with their care; however, knowing how certain dynamics play out creates the possibility.

Now, from this example there is a chain reaction: While the individual, committee, or outside consultant that is leading the efforts for cultural competence adds to the understanding of the quality/core measures leaders, the knowledge that is gained only has impact if those clinical and non-clinical professionals who are the touch points of patients and their families are made aware of what they can contribute to the fostering sustainable quality. It requires connecting with them, sharing with them, and getting their input in response.

Going further (interconnectedness is multi-faceted and inexhaustible but I won't go on and on after this example--maybe in a white paper ;-)) consider that soliciting and getting contributions from myriad areas and levels of employees, community members, volunteers, etc. fosters a level of engagement that creates ownership. Ownership of a thing, process, or idea fosters a relationship to it that engenders not just a good feeling but a level of commitment that leads to a greater contribution to the original idea as well as the many things that one might perceive support the original idea.

Jeremy Dean at PsyBlog says this about the psychology of ownership:

Effort increases perceived value: A table I have bought and struggled to build myself has more value to me than the same table I bought, for the same price, ready assembled. Expending our own effort means we've invested ourselves in an object, so it has more perceived value to us. Other people don't recognize this (and there's no reason why they should).

The bottom line is that when we leverage cultural competence as a strategy (and/or a core piece of your overall strategy) and we look for mechanisms to connect the dots from tactic to tactic, we naturally find how the pieces are seamlessly linked.

This is not to say that this is always easy. When we have been doing things a certain way for a long time change is challenging at its best. Nonetheless, when we truly understand cultural competence as a strategic approach vs. a tactic that speaks to checking something off of a list, the ROI can be tremendous.

Make it a great day!

Considering Immigration in Health Reform

Mr. Bhargava gives a compelling account discussing health reform and immigration. He points out that illegal immigrants are not driving up the cost of care. He is very much aware of the emotion underpinnings of the immigration debate and the realities of political leanings vs. the reality of situation. The writer clearly is an advocate for immigrants, but is also clear about the bottom line financial impact of this argument.

Make it a great day!

Don't Enshrine Discrimination in Health Care Reform
by Deepak Bhargava

Finally, the country seems serious about reforming health care. But with discussions about a public option, cost control and competition raging, one aspect of achieving true universal coverage is being left out: what to do about immigrants who lack coverage?

All of the plans getting serious consideration in Congress would exclude undocumented immigrants. Many proposals would even bar access to community health centers and emergency rooms -- a historic shift from America's humanitarian tradition that in an emergency no one should be turned away. Some proposals would exclude legal resident immigrants who have been in the United States for less than five years. Unless the debate takes a different turn, millions of immigrants will be left out of the system.

Health Disparities are Quality Disparities

The 2008 National Healthcare Quality Report and the National Healthcare Disparities Report from the Agency for Health Research and Quality were and are generally published each year at the same time.

This is very much appropriate, but it is hard to know if people are making the connection between the two reports. If we have health and/or healthcare disparities, particularly in the sense that with most things equal (SES, access, etc.) there are still disparate outcomes or disparities, what does that speak to?

Well, there are few things that we can consider.

1) Genetics: While the data on genetic predisposition is emerging there are pros and cons to this variable. A 2005 editorial The Role of Race and Genetics in Health Disparities Research out of the American Journal of Public Health summarizes the potential role of the human genome mapping in our evaluating causes and approaches to health disparities quite succinctly.

My experience is that given the long history of disparate outcome by race coupled with the emerging understanding of disparities in the LGBT, Disabilities, and other communities, genetics may play a role but the role that they play will be at best complementary.

2) Social, Environmental, Behavioral Factors: Health behaviors differ from person to person. Some of these behaviors are influenced by cultural health models and beliefs, experiences and responses to the health system and healthcare providers, and environmental circumstances. Behavior has and will always have an influence on health outcomes and behaviors will always be influenced by the behaviors of healthcare providers. So, the dynamic is a two-way street. There is evidence that experiences of healthcare providers (of all ethnic backgrounds) influence how treatments and recommendations for treatment are allocated. One classic study of this is a New England Journal of Medicine Article by Schumann, et. al.: The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catheterization.

While there were subsequent articles that questioned the authors' findings and the subsequent media attention that was generated, there was no denying the unequal treatment recommendations were prevalent and conclusive from the data collected in the study. This leads me to one last consideration (for now):

3) Quality Disparities: What do I mean by "quality disparities"? Let's move outside of healthcare for a minute and consider other industries where quality is vital (assume all industries believe it is).

For example, as the president of a company you have been delivering a high-quality product or service for quite sometime. Based on your evaluation and the responses of the customers, you are receiving feedback that what you are producing is consistently good amongst a majority of your customers. You are committed to quality because of your dedication to maintaining integrity but also due to the fact that your competition is fierce and while you are leading the pack, you never take your success for granted.

One day, it is brought to your attention that over 25% of your customers (by industry vertical, geography, or some other variable) are experiencing negative outcomes in the utilization of your product or service, yielding on average 2 times more problems than the other 75%.

What is your response? What do you think?

Well, one response is to say, "we have been delivering quality for so long, what is it with these 25%? We give everyone the same service consistently."

Another response is to say, "where is the breakdown?" Followed by, "is there something that we don't really understand about our customers that will help us serve them better?"

In an environment of stiff competition, you will do your research to understand who these 25% are, what exactly their challenges are and develop solutions to narrow the outcomes gap.

Or, you will decide that these 25% of customers are the problem and let them go, concluding that the 80/20 rule says that they are not necessarily benefiting you that much anyway. This may work or it may take you out of the #1 spot as the industry leader, especially if those segments are fast growing.

Back to healthcare. If 20% or more of our patients are experiencing worse health outcomes than the other 80%, obviously there are disparities there. More than likely, this is also what I would consider a quality issue even if we know that "we are treating everyone the same".

Why is this a quality issue? In fact, why are health disparities quality disparities? The answer lies not in the fact that hospitals are not delivering quality services. I believe that most facilities and individual practitioners are delivering very high quality services. I also think there are distinctions in what translates as quality.

Patient-centered care asks us to treat patients as individuals. It suggests that each patient is functioning and managing their health under a unique set of circumstances and if those circumstances are not understood to as great of an extent as possible, we may miss the mark on their needs short and long term and thus contribute to less than the best outcomes.

Missing the mark is reflective of the quality of services delivered for each person based on their unique needs that can sometimes be a result of archetypal dynamics of a particular group identity.

If over time, certain demographic segments are experiencing poor outcomes (just like a certain vertical or segment of a non-healthcare company) quality is being compromised. Your integrity is not compromised--you are doing all that you know how to do--but your outcomes are unequal and therefore certain groups are not getting what you intend for them to get and in some cases what you promise them based on previous experiences.

The response in healthcare has to be the first response described above for the hypothetical company--understand this population and develop solutions to address their problems. The second option of letting these customers go is not an option in healthcare. While there have been instances in which populations with greatest needs have been met with barriers to treatment because of the challenges they present, this is a response that given the times we are in and the realities of demography, we simply will not and cannot consider. We cannot do it morally nor can we shoulder it economically.

Aligning cultural competence with quality, affordable and accessible care is what the DHW Cultural Competence-Quality Framework for Healthcare Excellence is all about. Understanding that integrated efforts towards eliminating health and healthcare disparities (a core part of our CC-Q Framework) are a critical and central tenant in the quality care that all Americans desire is vital to assuring our success in reforming the healthcare system.

This post is a very short exploration of health disparities being considered as quality disparities. I would like to explore the idea of health disparities compromising our goal of quality affordable care in more detail. Please share your thoughts with me, the Diversity HealthWorks community and all those visiting our blogs.

Make it a great day!

Culture and Quality Part IV

A couple months ago (April 4) I began writing a series that I entitled Culture and Quality. As the conversation has evolved a new model has emerged. We have entitled it the: Diversity HealthWorks' Cultural Competence-Quality Framework for Healthcare Excellence.

The premise of the model is based on what we have seen over the past year in the diversity dialogue in all industries including healthcare: contraction and a general lack of cohesion about the future of what diversity and inclusion can be and/or needs to be in our corporations and organizations. We simply have not elevated the idea of diversity to that of a core business function that is unquestionable.

Now of course there are exceptions to this rule, but overwhelmingly, most people/companies frame diversity and inclusion as "causes" that they are committed to. Historically, the framing of what I call cause-oriented diversity and what it stands for have been absolutely necessary. To this day, this remains true. Nonetheless, herein lies the conundrum:

1. If diversity is more cause-oriented how does it line up next to other core business functions such as marketing, sales, fulfillment, and all related measures assessing core functions?
2. What if the "cause" of diversity is not held in at a steady level of urgency like other core business functions?
3. Since by their nature causes change--does diversity change or even potentially go away?

No matter how we answer these questions, and I am sure we could (and have) discuss each from different perspectives for days, the fact remains that if a cause-oriented diversity leaning is perceived as the norm, inevitably someone or some group can claim or feign that they are not accountable.

On the other hand, there is Quality. What about quality? Quality is. . .
--Unquestionable
--Valued
--Measurable
--Historical; and
--It is ALWAYS in the budget!

You will never hear any one say out loud that quality is something that is "nice to have but not a need to have". Quality is at the foundation of every organization in one capacity or another. Even if the ambition of delivering the "highest quality" of this, that, or the other is not yet realized, the ambition and possibility remain prevalent.

Healthcare is no exception. In fact, quality is at the core of how healthcare gets done. The President has made this very clear as the conversation about health reform has escalated. In virtually every address he has done around healthcare over the past 2-3 months he has talked about quality. On May 11th, in one of his speeches he said:

"I'm also committed to ensuring that whatever plan we design upholds three basic principles: First, the rising cost of health care must be brought down; second, Americans must have the freedom to keep whatever doctor and health care plan they have, or to choose a new doctor or health care plan if they want it; and third, all Americans must have quality, affordable health care."

This is a mandate that all of us can sign on to. Whether we are conservative or liberal, for or against universal healthcare, feel that healthcare is right or a privilege, quality, affordable, [accessible] care is something we can all agree is a priority.

So how does cultural competence fit in? Two answers:

1) Many hospital organizations have undergone culture change/quality initiatives driven by the likes of greats such as the StuderGroup or the work of Fred Lee (If Disney Ran Your Hospital). Some have had tremendous success, while others less so. Few have made culture change and competent culture evolution something they would consider embedded into how they do what they do each day or more so an ongoing discipline that is cultivated by leaders and cascaded down through the organization.

I hold that it is not because they don't want to. I fundamentally believe that it is because the culture change and quality efforts are not integrated with and inclusive of all of the facets of the organization. In particular many times the not included is the myriad diversity of employees, patients, families, and the greater community that make up WHO the hospital is as well as performs the functions of what it does.

So, I believe that there are cultures within culture change and that we have to develop and evolve our competence in these cultures within an organizational culture to assure continuous quality improvement.

2) We have created a model to discuss these dynamics and we want to share with you in a series of free web seminars. On July 1st and July 8th we will host two free web seminars to share the DHW Cultural Competence-Quality Framework for Healthcare Excellence.

The July 1, 2009 event will be for Diversity HealthWorks members only. If you register for this event and you are not a member of Diversity HealthWorks, you will not receive a confirmation link to the event. Membership however is free. So, if you are not yet a member and want to see a demo of the model and have the change to comment, Join Us.

The July 8, 2009 event is open to anyone interested. We look forward to seeing you on-line.

To register for the July 1, 2009 Free Web Seminar Click the Link Below:
DHW Cultural Competence-Quality Framework for Healthcare Excellence--July 1

To register for the July 8, 2009 Free Web Seminar Click the Link Below:
DHW Cultural Competence-Quality Framework for Healthcare Excellence--July 8


We hope to see you as we share this integrated framework with all who are interested.

Make it a great day!

Draft Summary on Health Reform Bill from the House Ways and Means Committee

This summary released June 19, 2009 gives an overview of the provisions intended as part of the bill. Read it and know that the actual draft of the bill will have layers of stuff that is both reflective and not so reflective of the summary. I hope that people actually read it before they go about criticizing it.

Transparency has been a mantra out of the Obama administration and we have to consistently hold them accountable to this. So far, I have felt like they have done what they said they were going to do. This means we should trust them to continue, but not depend on it so that we become complacent.

Draft Health Care Reform Bill Summary

Make it a great day!

Expanded Jobs, Streamlined Tools at IMDiversity.com

The IMDiversity.com Career Center and Multicultural Villages network are migrating to a new jobs database and tools format this month, featuring expanded network jobs listings in healthcare and other other sectors, as well as streamlined tools for creating a custom job tools account, searchable resume, and personalized email job alert agents. We invite diverse jobseekers to visit the beta at http://jobsearch.imdiversity.com.

Special Note for Existing Users: Please note that those who previously created accounts on IMDiversity's former jobs site will still be able to access their tools, resumes, and application histories for a brief time during the transition at http://jobs.imdiversity.com. However, as of June all new healthcare openings will now be posted on the new job bank, and all users are urged to create a new account at http://jobsearch.imdiversity.com/jobseeker/create as soon as possible. (Please note that your old username and password will NOT work on the new system.)

Following the final release, we will be restoring many of the additional quicksearch tools on the IMDiversity.com Healthcare Careers and Readings Channel at http://www.imdiversity.com/healthcare.asp.

Minority Politicians and Health Disparities: The Messenger, the Message

In 2002 the Institute of Medicine through the actions, concern and political will of the minority caucuses of the U.S. (primarily House Democrats)making a request to the National Academy of Sciences to create a comprehensive report (Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care) on ethnic and racial disparities that has become one of the definitive if not the most definitive report on health disparities that has ever been published.

The publications created a foundational conversation that, as I have shared before in other writings, politicized the issue and raised the level of the conversation. This has been a very good thing.

However, what has not happened is a moving of the health disparities conversation from a single-faceted issue to one that is central to the success of our healthcare system and to the overall success of health reform.

Quality accessible healthcare, cultural competency, eliminating disparities, workforce diversity, patient-centered care and many other aspects of what one would consider successful outcomes of healthcare organizational excellence are all necessary to consistently make successful outcomes a reality.

Now, more so, than perhaps any other period in recent history is time to align our message and enroll messengers to deliver it consistently.

So, on Monday(6/8)there was a flurry of activity in the media announcing that the Congressional Black Caucus (CBC) sent President Obama a letter outlining their desire to assure that health disparities are a core issue in the health reform conversation. They had a meeting about this and subsequently, Health and Human Services Secretary Sebelius published a report (I say a Brief) entitled Health Disparities: A Case for Closing the Gap that outlined some of the pertinent health disparities issues connoting a need for the issue to be addressed comprehensively as part of health reform. It was published on HealthReform.gov.

I agree with the need to focus, who wouldn't. However, I am concerned by two things in particular:

1) The Messenger. Health disparities is a very broad and complicated issue. Even though racial and ethnic disparities are very prevalent and have been central to the issue, what we are facing is much bigger. We are facing the dynamics of access combined with multiple populations that are vulnerable to adverse health outcomes regardless of accessibility of services and not because of their race or ethnicity.

HEALTH DISPARITIES IS AN ISSUE THAT IMPACTS ALL AMERICANS.

So, my concern is that the messenger is generally minority. This is not a bad thing, someone has to say something. The challenge is that when the CBC and other minority caucuses are the predominant leaders in this conversation about how to make health disparities a part of the overall health reform agenda, the issue settles consciously or unconsciously in many of our minds as an issue that they are responsible for. An issue that is all about them.

By not consistently engaging and enrolling a variety of groups such as representatives from the Lesbian, Gay, Bisexual, and Trans-gender communities, the disabled, veterans, non-minority women, and others we miss the opportunity to frame health disparities, health equity, and cultural competency as an issue that simultaneously is inclusive of and transcends "minorities". It is an issue that affects everyone living in the U.S. directly or indirectly.

2) The Message.
--What is framework for the health disparities conversation within the context of health reform?
--What does it need to be?
--As a health professional or other professional, if you believe that addressing health disparities, quality affordable/accessible care, cultural competence, patient-centered care are important: How do you articulate their interdependence? (more)

Beware of Half Truths about Healthcare Reform

That a lie which is half a truth is ever the blackest of lies;
That a lie which is all a lie may be met and fought with outright;
But a lie which is part a truth is a harder matter to fight.
-- Alfred Tennyson Tennyson

I could write for 2 hours about the many articles that I have read that give a very incomplete, data-lacking, sub-par, politically spun (on all sides) overview of the healthcare landscape along with the possibilities and potential pitfalls of healthcare reform how it is being described to date. I won't bore you or reinforce their political positioning with more links.

This one, I will share because it well represents all that can do harm in terms of the dissemination of incompleteness of information in our society. I wrote a response to one article (there were many half truth/half fiction/anecdotal pieces) and I wanted to share it.

Let's be clear, there is going to be a battle in the reformation of our healthcare system in the U.S. I hope we can at the least share some full truths along the way as we get there.

In response to the blog at Public Plan Facts (loosely used word--"facts")

I am 100% for sharing both sides of a story. From what I have read there is intentionality in the writers for this site, not doing that. The rhetorical argument is one-sided and when citing stats only gives the content that supports your argument "that healthcare reform how we see it is bad for Americans and bad for the country" without presenting information that even edges close to being balanced.

These tactics will not work with the American people any longer. If the 2008 elections have told us anything, the people want to choose not be emotionally cajoled into thinking a particular way or resisting something based on incomplete information.

Say what you feel you need to say. Intentionally omitting important information or spinning the information that is out there is absolutely harmful to people and I hope that your tactics don't cause more harm than good.

Make it a great day!

National Healthcare Quality and Disparities Reports and more. . .

Over the past month there have been a few reports released that I felt important to share.

The first is from the Agency for Healthcare Research and Quality, their National Healthcare Quality and Disparities Reports.

This is the sixth year for these studies and given our current ramp up of the healthcare reform conversation, they are probably more important than ever. It will be critical for those who have a voice (that means you!) to make sure that we consistently align healthcare quality with eliminating health and healthcare disparities and leveraging cultural competency to see successful healthcare reform.

Quite simply as I have been sharing the past couple months, cultural competency and quality must be aligned and the elimination of healthcare disparities must be addressed if we are going to in earnest make a difference in the transformation of healthcare in this country. I believe it and I will repeat it over and over again as we get deeper into the health reform dialog.

The other report that was phenomenal comes out of the Canada-based Centre for Research on Inner City Health. They are doing such thoughtful and relevant work and have been doing so for some time. <more>

Getting There from Here: A History of Healthcare Reform from the New Yorker

This is one of the best, if not the best, most well-balanced articles on the realities of healthcare reform that I have read.

It is lengthy, but it hits home as to where we are going, where others have been, and the realities of moving forward with an understanding that there will be necessary hiccups along the way.

Annals of Public Policy: Getting There from Here: newyorker.com

Shared via AddThis

What is your message?

I am learning to be a better presenter. While I present for a living, when using PowerPoint, I know I can share ideas more effectively.

Learning to present with excellence is vital to organizational success. When selling yourself for a new job, selling an idea internally, or doing a sales pitch or presentation for funding, good slide presentations make a huge difference!

While I am preparing to talk to people publicly about Diversity HealthWorks' model on Cultural Competency and Quality, I have come across many good pieces on how to present effectively. This slide show is just one of many.

Use it, present with effectiveness. Know what your message is and what your audience wants/needs. And as always. . .

Make it a great day!

Good PowerPoint Design - for business presenters

View more Microsoft Word documents from Alexander Osterwalder.

I Determine What is Relevant

Since May 11th and the President's remarks on May 11th about reforming the healthcare reform, I thought that I needed to write something in context about cultural competency and quality or at the least give my perspective on how health disparities have to be considered if we are going to make any sustainable change in healthcare as a whole.

I pondered what to write and even scratched out an outline of the points I wanted to make sure I explained thoroughly. After pondering and outlining and pondering some more, I realized that I needed more perspective. So, I began to read more blogs and opinions and tweets of those for universal coverage and those against what is being labeled as "socialized medicine".

The amount of information and disinformation and opinion is startling. I have a decent grasp of how the healthcare system works from point of care to process of payment and beyond. Yet, making sense of all the opinions about what health care reform must do, what it will create negatively and positively, to those who believe that the system is fine and that changing it will cause health plans to fail, to those "Good Americans" that simply want everyone to pay their way, is mind boggling to me. I cannot imagine what a person who has not been trained in these dynamics experiences when trying to connect the dots.

My conclusion is that "I determine what is relevant". Now, the "I" in this statement does include, I, Amri. It also includes you, reader. It also include you, pundit, politician, President, Peter, Paul, and Poppins, and potificatoblogwriterspindoctorsincerejournalistpeacemakerparent. (More)

Diversity, Disease Management and the Business Case for Addressing Disparities in Healthcare

We recently shared a new (actually updated) white paper that we published initially in 2004 and wanted to share it in brief on our blog(s) so that those who did not get the opportunity to see the full paper can be made aware of it and access it if so desired.

For those who are subscribers to Diversity HealthWorks your copy is free. If you have not received a copy, please send me a message through the network.

If you are interested in receiving a complimentary copy of the white paper: Join Diversity HealthWorks or if you would like to purchase a copy please click the link below:

The first few pages are included below for your review. If you have questions, always feel free to contact me, Amri Johnson. You can find our contact info at our website.

Diversity, Disease Management, and the Business Case for Addressing Disparities in Healthcare

____________________________________________

Introduction

The conversation about differences in health outcomes for minorities and whites in the U.S. has been documented in the academic literature, in detail, for many years (U.S. Department of Health and Human Services (DHHS), 1985). Nonetheless, the past 10 years has significantly increased and framed the conversation about differences into the issue of “health disparities”.

Prior to the release of Healthy People 2010, which focused on decreasing (towards eliminating) the differences in racial and ethnic health outcomes, the dialogue was understood and often studied by researchers in the academy; however, mainstream America did not have clarity on the degree of the problem and how to address it. With Healthy People 2010, then Surgeon General David Satcher introduced the term “Health Disparities”.

The introduction of this term allowed for a broader dialogue about the direct and indirect impact of health disparities on multiple players in the health care system. It also created further inquiry as to the causes. In 2002, the Institute of Medicine released its publication Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care that documented the various reasons for disparities as well as offered suggestions on how to address them.

Unequal Treatment was groundbreaking because it opened the discussion up to a more mainstream audience. However, the opening was not exhaustive enough that it could frame the issue in a way that was seen outside of health circles as a bottom line issue that affected all U.S. residents.

As most Americans are aware, the demographics of the country are rapidly changing. For example:

• Currently one-third of Americans are racial and/or ethnic minorities
(Census, 2000)

• By 2020 the Bureau of Census states that over 40% of the U.S. population
will be racial/ethnic minorities

• In the next decade 41.5% of workforce will be racial and ethnic minority
(Bureau of Labor Statistics)

• Over 50% of all U.S. immigrants entered the country since 1990

These statistics translate into a greater necessity to give the issue of health disparities the attention it needs by all who are affected. In particular those affected include: medium and large employers with growing ethnically diverse workforces and taxpayers who pay for the services of the largest employers in the country: federal, state, and local government. As mentioned above health disparities impact all Americans.

By framing disease management, corporate diversity initiatives, and health disparities in a similar context, this paper will illustrate how the business case for addressing each are aligned. In addition it will illustrate how an organization can proactively integrate addressing health disparities into existing practices such as diversity and disease management.

Disease Management and Healthcare Cost

With increasing costs of healthcare, employers (large and smaller), health plans, and healthcare providers have explored and tapped into various methods to address the challenges of managing cost. Myriad programs have been implemented, starting with managed care’s flourishing in the 1970s up to today’s emphasis on Disease Management (DM) which started in the 1990s.

The Disease Management Association Defines disease management as:

A system of coordinated healthcare interventions and communications for populations with conditions in which patient self-care efforts are significant. Disease management:
• supports the physician or practitioner/patient relationship and plan of
care,
• emphasizes prevention of exacerbations and complications utilizing
evidence-based practice guidelines and patient empowerment strategies,
and,
• evaluates clinical, humanistic, and economic outcomes on an on-going basis
with the goal of improving overall health.
Source: (http://www.dmaa.org/definition.html)

While DM is, in theory, indicated as promising where cost savings are concerned, there is very little to no extensive, longitudinal, empirical evidence to indicate sufficiently that such savings are being realized. Al Lewis, Executive Director of the Disease Management Purchasing Consortium and DM ROI expert states, “For the first seven years of the eight year history of DM, nearly every result was tainted by erroneous measurement.” Mr. Lewis has also postulated that understanding ROI for DM is just now starting to gain ground where solid measures and a gold standard are concerned (www.dismgmt.com). Despite sparse empirical evidence supporting DM, DM as an industry has flourished with revenues (primarily paid by health plans) growing from $87 million in 1997 to over $600 million in 2002 with projections of over $1 billion. The Boston Consulting Group has gauged the DM market in 2005 at approximately $1.2 billion. They indicated a 40% compound growth rate of 40% since 1997 similar to the above statistics; and predicted growth to $1.8 billion in 2008. They deduced that the market would reach maturity at around more than $3-4 billion. (“Realizing the Promise of Disease Management Boston Consulting Group 2006)

Corporate Diversity Programs

Corporations have heavily embraced diversity programs over the past 20 plus years. From supplier diversity to employee-focused/workforce diversity programs, most of the Fortune 1000 and many others have specific diversity/inclusion programs being implemented or built into their current HR employee on-boarding/training programs or overall corporate culture.

While most programs were initially developed reactively out of adherence to affirmative action and compliance regulations; currently, many companies are acutely aware of the various positive outcomes and are working proactively to measure diversity’s impact on their corporate bottom line. From employee engagement to measuring ROI through diversity efforts in marketing, recruitment, or other streams of revenue or cost savings, the case for diversity for many has become a part of how business gets done is more and more a mainstream idea for large to medium-sized employers. This emphasis is an evolution as well as a response to some critics that argue against diversity programs being of any bottom line value to an organization. One such critic, Thomas A. Kochan, one of the most respected human resources management scholars in the country from MIT’s Sloan School of Management states, “The business case rhetoric for diversity is simply naïve and overdone. There are no strong positive or negative effects of gender or racial diversity on business performance.” Other arguments are, of course, to the contrary including Luke Visconti, co-founder of Diversity Inc., a leading diversity publication, who states, "It defies gravity and flies in the face of logic," he says. "I can’t even imagine how someone could come up with that conclusion unless there was no diversity among the people doing the study.” In dismissing Kochan’s research, Visconti is stating that anyone who cannot see the value of emphasizing diversity, does not understand the changing demographics of the United States; or, is blind to the anecdotal examples and intangible benefits that companies are experiencing that have yet to be measured empirically.

While these arguments state opinion, more recently authors such as Dr. Scott Page’s book The Difference and Frans Johansson’s The Medici Effect which both suggest that diversity drives better solutions and greater innovation respectively. Many have taken these authors’ research and insights into account as they continue to illustrate how inclusive and diverse work environments are a key to organizational success.

The former comments above have been a part of the diversity industry for a long time, while those of Page and Johansson are more recent. Nonetheless, even though professionals that work in the industry are clear about the need for making diversity a sustainable part of our organizational cultures, we have often seen the commitment by companies to be forsaken. This has especially been the case since the economic recession in 2008-09 has forced corporations to make budget cuts. While diversity is valued, it has still been one of the first places to take budget cuts.

(Interested in receiving a complete copy of this white paper? visit Diversity HealthWorks)

Make it a great day!

Culture and Quality Part III--10 Resources

In lieu of another article in this part, I decided that sharing resources that will help you frame culture and quality together would be valuable. While I intended to share these resources in the final quarter so to speak, I thought they would be helpful now.

By no means is this meant to be a definitive list. In fact, I welcome suggestions on what should be added to it that allows us to see the connections between cultural competency and quality more clearly. We want (continuing for some and beginning for others) to make this an integral part of our foundation for creating seamless connections of cultural competency, diversity, and inclusion with our collective organizational quality development, mission, and of course, for healthcare reform.

Culture and Quality: Joining the Levers (2002)
Dr. Mark D. Smith, MD, MBA, CEO of the California Healthcare Foundation clearly illustrates the movements of cultural competency and quality and their connection. He frames the presentation around “What are we going to do?” It is important to note that this was 2002 when Dr. Smith presented at the Third National Conference on Quality Health Care for Culturally Diverse Populations. It is 2009, the issue has risen in priority, the presentation is very timely to this day.

The Providers Guide to Quality and Culture
Management Sciences for Health has created a very comprehensive website focused on Quality and Culture for healthcare providers. This site is very comprehensive and frames the quality dynamics with succinct descriptions and a broad grouping of subjects. The site was created with the U.S. Department of Health and Human Services, Health Resources and Services Administration, and the Bureau of Primary Health Care.

National Center for Quality Assurance (NCQA) Efforts
NCQA has taken great efforts to align quality and cultural competency for health plans. In fact, many health plans have been actively making cultural competency and the reduction/elimination of health disparities a priority for years. (more)

Eliminating Health Disparities and Health Reform Go Hand in Hand

Groups Call on President to Address Health Disparities in Health Reform
The case is building and the time is now to really begin to get a grasp on health disparities. Cultural competency and quality will by their nature be a part of that conversation. Are we ready? What do we need to do to be ready?

Culture and Quality Part II

The idea of connecting cultural competency to quality is not one that is new. In fact, there are products and people who have been in this mode for a long time. For example Resources for Cross Cultural Health has hosted a conference entitled National Conference Series on Quality Health Care for Culturally Diverse Populations, which they have hosted since 1998.

In addition there are people like Joe Betancourt, MD, MPH who was one of the principal authors of the IOM report Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare published in 2002 who along with his colleagues and leading health disparities researchers, Emilio Carrillo, MD and Alexander Green, MD, MPH created the cultural competency educational tool, Quality Interactions. The name of this product, that teaches health professionals about cultural competency indicates that the creators aligned cultural competency with quality from the beginning of its creation. Thus, as leading researchers and thought leaders in the field they get that cultural competency goes hand in hand with quality healthcare.

So, the idea is not new. However, the idea of aligning quality with cultural competency is not commonly practices. It is not practiced in healthcare where one may consider it to be obvious since the bottom line of healthcare delivery is quality and efficacy. It is why we focus so much on evidence-based practice. Nonetheless, a conscious and consistent conversation aligning the concepts of cultural competency with that of quality has yet to come to light for the majority of healthcare organizations. more

Kaiser Permanente CEO, George Halvorson's New Book

I saw on one of the blogs (Patient Centric Healthcare) I traverse, that the CEO at Kaiser Permanente is writing a book. I think fondly of Kaiser as a leader in cultural competency, diversity and inclusion. And want to make sure that if you are interested in what a great mind that works with several great minds, (i.e. Ron Knox, Melanie Tervalon, Edgar Quiroz), that IMHO knows the business of healthcare from many angles, and gets the connections between healthcare reform and the responsibilities of healthcare organizations towards both cause-oriented and quality-oriented approaches, pick up the book when it is released!

Upcoming Book By George Halvorson From Kaiser

Check out the blog post and interview.

Visit Diversity HealthWorks I will share the book and a link with members when I pick up my copy!

Make it a great day!

Convergence is Cool

There is not much to like about an economic recession. There is at least one thing: Innovation expands when other things are contracting. When you don't have a lot to work with you find ways to work more creatively with what you've got.

As I am preparing to write the second part in the series, Culture and Quality, it is amazing (even before April/Minority Health Month came upon us) how much health disparities are being discussed (more)

Will Giving Patients Knowledge of their Physician's Race Reduce Health Disparities?

The Kaiser Family Foundation website listed an article about the preliminary results of a telephonic study done by Highmark looking at patient preference for having race listed when they are choosing a physician (more)

Culture and Quality Part I

For many candidates and employers/managers the question of "Where do you want to be in 5 years?" is a common one ask and responded to in interviews and performance reviews. In the work that we are doing to reform/transform healthcare, the idea of where we want/need/have to be in 5 years has been often coupled with the angst people feel about where we are and the past 5-10, 20+ years that has gotten us to where we are today.

I need not rehash the myriad dynamics that face us today. What I want to point out however, for us with a desire to create consistent and sustainable excellence in healthcare, is that we couldn't be in a better position to create something truly transformational. The question here is: Where do we need to go?

Why is the window of opportunity for transformation in healthcare wider now than we may have ever seen before? There are multiple reasons, I will name just a few: more

Patient Centeredness, Cultural Competency, and Health Quality

Recently, I have been talking more and more about connecting diversity and cultural competency to quality. It is not a new conversation but it is in fact one that has been on-going yet not embraced as a concept that gets healthcare organizations to raise the level of dialogue to that with more inclusive framework or positioning so to speak. Aligning cultural competency and health disparities consistently with quality can lead to what I feel can create a more powerful impact on all those who can affect transformation.

I came across an article out of the Journal of the National Medical Association (JNMA) by Drs. Saha, Beach, and Cooper that speaks to it and I wanted to share it with you today.

Patient centeredness, Cultural Competency and Health Quality from the JNMA

Make it a great day!

Supply, Demand, Universal Coverage as Transformational?

I saw a blog post from my Twitter stream today that was quite interesting by the Compass Group, Inc. They have great a great blog by the way. I am following it as soon as this posting is completed.

What it stimulated for me was examining the framing of the whole universal coverage conversation as this dynamic of contention as well as the wording. My response to the article which talked about supply and demand. "Supply goes down, prices go up"
the article shared, especially where personnel are concerned.

This theme was in relationship to what health reform would really create as an effect in terms of bringing costs down if there is already a weakened supply. Naturally the economic rule/principle applies and how can we avoid it?: They say greater efficiency and I generally agree.

My feedback to the blog post was as follows:

Great article. What strikes me about what you describe is whether or not we will actually increase those seeking care? If indigent care is costing a public hospital like Grady Memorial Hospital in Atlanta where I live more than $250 Million per year and umpteen billions nationally , what happens if there is coverage? Is it possible that the result of universal coverage is increased employment of healthcare professionals, better preventive measures, and fewer complex procedures that are paid for through premiums of the insured and state and local government intervention? I am not saying that it is going to happen, but is it possible?

What kind of country do we want to live in? One where some are sick and cost those who are well and/or are getting care significant resources and perhaps resentment (like now)? or One where all can be taken care of, not at the expense or resentment of others?

My premise is that a well thought out universal coverage (not universal healthcare control as some interpret or socialized medicine as some fear) system can actually create a healthcare environment that benefits practically everyone, haves and have nots, those currently covered and those not covered, the employed and unemployed, etc. Essentially, we would be on the road in my opinion towards tackling health disparities, addressing cultural competency with a reduced access burden allowing us to really make it a QUALITY dynamic in addition to a moral or regulatory one, etc.

We have a choice, resist change to extent that we see things repeat themselves or start correcting the path we are on, adjust along the way and step into possibility. We all know something has to be done--what are we resisting when we dismiss it other than the notion that as individuals we might get less than we have now? Notions of that nature will do little to transform/reform/elevate our healthcare standing and our standing for being as great as this country is.

Make it a great day!

HCAHPS and Cultural Competency

Stay tuned for new tools and content related to regulatory cultural competency via Diversity HealthWorks.

Our plan is to share something your organization needs to be aware of and how it to execute what is coming into your overall strategy.

Since Dr. Weech-Maldonado's research in this phase has come to an end, we are already seeing many research-based and tested instruments to measure cultural competency in organizations. There are some good ones, we will share a few and if you know of others, please contact us. Of course, if you share it with me, I will share it and let people know who sent it :-) None of the tools to date, in my opinion, are better than others at this point and you will have to see which one works best for your organization

Stay tuned. . .and Make it a great day!

Development and Testing of the Patient Assessments of Cultural Competency Survey

End Date: February 28, 2009
University of Florida
P.O. Box 100195
Gainesville 32610-0195
Principal Investigator: Robert Weech-Maldonado, M.B.A., Ph.D.

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys have been used to assess racial, ethnic, and linguistic differences in patients' experiences with care. There are concerns, however, that the surveys do not fully capture aspects of the care experience that are particularly relevant to minority patients, such as access to language services and perceived discrimination. The goal of this project is to test, validate, and disseminate a new survey—the Patient Assessments of Cultural Competency (PACC)—that addresses issues of cultural competency. Once the project team has established the survey's reliability, it will create a short version of the survey to serve as a supplemental module for the CAHPS instruments. The Agency for Healthcare Research and Quality and the National Committee for Quality Assurance have both stated their intention to collaborate on dissemination of the PACC survey.

Kaiser Permanente Ads Call Attention to the Issue of Health Care Disparities

Kaiser Permanente quite simply is leading healthcare organizations in the direction that I think they absolutely have to go--forward in making health and healthcare disparities a strategic priority. The issue is both political and moral, clinical and organizational. It mirrors societal diversity and inclusion conversations and what are often considered business considerations in that the insured, under insured, and uninsured all work for employers and as employers. Are you part of a healthcare organization looking to share best practices? If so, take Kaiser as an example. . .
Kaiser Health Disparities Ads Call for Action

U.S. Surgeons General Decry Disparities

We talk and talk and talk about disparities and many (I would say, all) of the Surgeon Generals of the past 20 years have made minority and ethnic disparities a priority directly or indirectly. Dr. Koop focused on smoking and the difference he made was huge. He had help before his platform took root from many public health leaders throughout the country.

As we move towards forward in transforming health care is it worthwhile for us to make health disparities (which affect us all) the leading issue in moving the needle forward? I am talking about doing this in a manner similar to how we approached the tobacco work. Here is the article. . .
Access remains key to health care, surgeons general explain in Orlando

Job-Bias Claims Soar to Record High in 2008, EEOC Says

This is a well-known fact amongst diversity and inclusion professionals. We have entered a new day, this trend will not go down. Expect at least 100,000 for 2009 if we don't keep our eye on sincere engagement of our workforce and customers.

EEOC Claims Increase
Overall employee claims with the EEOC jumped to 95,402, the most since the agency opened its doors in 1965. Retaliation claims were second in number only to those alleging race discrimination.
http://www.workforce.com/section/00/article/26/24/29.php
from Workforce Management

Make it a great day!

Racial Health Disparities: The Civil Rights Issue of Decade?

A few years ago, Congressman John Lewis said to me in an interview that "healthcare is the Civil Rights issue of the 21st century". The American Medical Student Association has for a long time been dedicated to address racial and ethnic disparities. This article coming from sessions at their annual conference is reflective of that commitment and what the Congressman declared over four years ago. . .

Racial Health Disparities Called Most Prevalent Civil Rights Issue of Decade
from Diverse Issues in Higher Education